Sunday, May 17, 2020

Welcome to FromDC2Iowa: Contents & Guide

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Latest Half-Dozen Posts (Full Text)

How You Can Help Fight COVID-19

"[I]n early May [Iowa Governor Kim] Reynolds . . . stopped announcing daily cases and deaths on TV . . . [and] sending out those statistics with news releases to the media and posts to the governor's website . . . at a time she is increasing the ability of Iowans to sit down for a meal at a restaurant, get a haircut, work out at a gym and go shopping [saying] 'Iowans are going to take the responsibility to decide if they are ready to go out and participate at the businesses or go to a restaurant.'"
Vanessa Miller, "As Iowa Reopens, Stat's Virus Data Elusive; Citing Lack of Help from Reynolds, Some Keep Their Own Tallies," The Gazette, May 17, 2020, p. A1

In other words, we're being asked to make our own decisions about avoiding COVID-19 -- and at a time when our Governor has stopped reporting deaths during daily video reports, and otherwise obfuscating what data remains.

What to do? I guess we'll have to gather our own data. Fortunately there's a way to do that -- one that takes less than a minute a day, costs nothing, and is risk free.

Willing to help? Read on.

What I'm talking about is the creation of Professor Tim Spector, MD, Genetic Epidemiology, King’s College London, and Professor Andrew Chan, MD, MPH, Harvard Medical School and Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health.

It's an app for either iPhone or Android called Covid Symptom Tracker, and over 3.6 million people have downloaded the app and report in every day on their symptoms. If you are symptom-free, as thankfully I have been, it literally talkes less than a minute to click on the app, select the "me" profile, click on the "I have never had a COVID test," and "I feel physically normal."

If enough people in your county have signed up your app then displays the number of people in your county who are reporting COVID symptoms.

I am in Johnson County, Iowa, and at the time of writing we need an additional 223 people to participate to get that report.

To get the app go to your app store and search for "covid symptom tracker." It should be at the top of the list. If not, look for the logo displayed here.

And thank you! Spread the word.

More about Covid Symptom Tracker

To find out more about this project from those who created and run it: https://covid.joinzoe.com/us/about

And see:

Andrew Jacobs, "App Shows Promise in Tracking New Coronavirus Cases, Study Finds; The app, which allows people to record their symptoms, was remarkably effective in predicting infections. The most reliable indicators, researchers found, were loss of smell and taste," New York Times, May 13, 2020, p. A4 ("In the absence of widespread on-demand testing, public health officials across the world have been struggling to track the spread of the coronavirus pandemic in real time. A team of scientists in the United States and the United Kingdom says a crowdsourcing smartphone app may be the answer to that quandary.

"In a study published Monday in the journal Nature Medicine, researchers found that an app that allows people to check off symptoms they are experiencing was remarkably effective in predicting coronavirus infections among the 2.5 million people who were using it between March 24 and April 21.")

Charlotte Jee, "A New App Might Help Researchers Monitor the Spread of Coronavirus," MIT Technology Review, March 25, 2020

David M. Halbfinger, "How Are You Feeling? Surveys Aim to Detect Covid-19 Hot Spots Early; Scientists have persuaded Britons and Israelis to fill out questionnaires about their health, to get ahead of the coronavirus by getting resources to the right place. The U.S. is next," New York Times, April 1, 2020

"COVID-19 Symptom Tracker App," News, Massachusetts General Hospital, March 31, 2020

# # #



Andrew Chan, COVID-19, Covid Symptom Tracker, epidemiology, Governor Kim Reynolds, symptoms, Tim Skpector, Vanessa Miller

Thursday, April 30, 2020

January 20: Another Date Living in Infamy

AND
COVID-19: THE ESSAYS COLLECTION
Contents
Letter to The Gazette
Sources for Letter
Supportive Commentary and Other Thoughts
Introduction and Qualifiers
Nonfeasance, Malfeasance, Involuntary Manslaughter, and the Sum Total of Human Knowledge
Sampling President Trump's Comments
Why Test-Trace-Quarantine-and-Test?
A Global Pandemic Calls for Global Solutions
Doing the Wrong Thing Better
South Korea's Awesome COVID-19-Fighting Apps
Exponential Growth
Why Infamy?
Nick's COVID-19-Related Writing
January 20: Another Date in Infamy
Nicholas Johnson
The Gazette, April 26, 2020, p. D2

Jan. 20, 2020 is "a date which will live in infamy," to borrow President Franklin Roosevelt’s labeling of the Dec. 7, 1941 bombing of Pearl Harbor. Jan. 20 was the day both South Korea and the U.S. had their first CORVID-19 cases. [South Korean President Moon Jae-in and first lady Kim Jung-sook wearing masks to prevent contracting the coronavirus disease (COVID-19). Photo credit: Yonhap via Reuters]

Twenty days later South Korea had flattened the curve. Along the way it had the second highest number of cases globally, but by April 20 the threat was over -- while keeping many businesses and factories open.

A Seoul official credits “quick government intervention, tracking and isolating infected personnel, and a transparent information hub” – plus a dozen amazing apps. All things we could and should have done.

WWII cost $4 trillion (today’s dollars) and 407,000 lives. Our unconscionable federal lack of prompt response to the virus will cost much more in unnecessary dollars and deaths. And that’s why this year’s Jan. 20 is another “date in infamy.” For sources and more see, https://tinyurl.com/y7swfgqy

Nicholas Johnson
Iowa City

# # #

Sources

Kanga Kong, "Seoul’s Full Cafes, Apple Store Lines Show Mass Testing Success," Bloomberg News, April 18, 2020

David Lee, "Coronavirus: lockdowns are not the reason Hong Kong and South Korea are beating Covid-19. Model citizens might be," South China Morning Post, April 21, 2020

Aylin Woodward, "South Korea controlled its coronavirus outbreak in just 20 days. Here are the highlights from its 90-page playbook for flattening the curve," Business Insider, April 18, 2020

Doug Whiteman, "The Financial Facts You Never Learned About World War II," MoneyWise, July 4, 2019

"World War II Casualties," Wikipedia.org

# # #

Supportive Commentary and Other Thoughts

Introduction and qualifiers: Like many policy wonks, and everyone tracking the print, online and broadcast news since the revelations from China in December and January, my disproportionate focus has been on the global COVID-19 pandemic. I claim no expertise regarding these issues. I am neither trained nor experienced in medicine, epidemiology, or public health. Although I once served as a co-director of the Iowa Institute on Health, Behavior and Environmental Policy, our major focus was on America's 400,000 annual deaths related to tobacco use -- not global pandemics. My facts and opinions come from material publicly available to everyone -- including what's public of what President Trump could and should have known from reports and his staff since last November (and earlier). (Rem Rieder, "Contrary to Trump’s Claim, A Pandemic Was Widely Expected at Some Point," FactCheck.org, March 20, 2020)

Nonfeasance, Malfeasance, Involuntary Manslaughter, and the Sum Total of Human Knowledge

As a law student I served as assistant (the school called assistants "Quizmasters") to an elderly, quite proper, kindly and helpful professor. As such I sat through his contracts course, although I had earlier taken the class from another professor, to better assist with grading papers. I do not recall his question on the occasion I'm about to describe, nor do I recall the student's answer. But I clearly recall the shocked expression on the professor's face -- one I had never before seen -- and his long pause before responding. Finally he spoke, in his soothing drawl: "Young man, you have a capacity for subtracting, rather than adding, to the sum total of human knowledge."

Those were the only personally judgmental words I ever heard him speak, but they leapt from my aging memory bank the other day when I heard our president ask one of his epidemiologists whether a cure for COVID-19 might be the injection of bleach or other disinfectants into the bodies of COVID-19 patients. "That," I thought to myself is another example of "subtracting, rather than adding, to the sum total of human knowledge." (Allyson Chiu, Katie Shepherd, Brittany Shammas and Colby Itkowitz, "Trump claims controversial comment about injecting disinfectants was ‘sarcastic,’" Washington Post, April 24, 2020 (with video of remarks)

It is reminiscent of the old saying directed at an unhelpful participant in a group dealing with a crisis: "Lead, follow, or get out of the way." When it comes to COVID-19, Trump won't lead, he won't follow the example of other world leaders or the advice of America's experts, and he refuses to get out of the way.

Which brings us to the distinction between "malfeasance" and "nonfeasance."
"Malfeasance. Intentional conduct that is wrongful or unlawful, especially by officials or public employees. Malfeasance is at a higher level of wrongdoing than nonfeasance (failure to act where there was a duty to act) or misfeasance (conduct that is lawful but inappropriate)."
Malfeasance, Legal Information Institute, Cornell Law School.

We're not concerned with the "legal" definitions, or legal consequences. For our purposes the point is simply that a public official, such as our president, can fairly be judged not only by the intentional harm that he does but also by the harm that results from his inappropriate responses -- and by his failure to act at all when action is clearly called for.

The Code of Iowa, Chapter 707, deals with "Homicide and Related Crimes." One of the definitions of first degree murder is when "The person willfully, deliberately, and with premeditation kills another person." Section 707.2 (1)(a). What if a person has no intention to "willfully, deliberately" kill anyone, but "unintentionally causes the death of another person by the commission of an act in a manner likely to cause death or serious injury"? That is one of the definitions of "involuntary manslaughter." Sectiion 707.5 (1)(b)
As an interesting sidebar, note that there is an equivalent law governing "death by smart phone." It is "a class 'C' felony when the person unintentionally causes the death of another by any of the following means: Driving a motor vehicle in a reckless manner with willful or wanton disregard for the safety of persons or property .... [A] person’s use of a hand-held electronic communication device to write, send, or view an electronic message while driving a motor vehicle shall be considered prima facie evidence that the person was driving the motor vehicle in a reckless manner with willful or wanton disregard for the safety of persons or property ...." Section 707.6A (2)(a)(1).
The point of this mini-essay is not to make a legal case for the criminal prosecution of the president or anyone else. It is to make a moral, ethical and theological point with huge economic and public health consequences. What we are dealing with is not "just Trump being Trump." We are suffering under a president whose non- mis- and malfeasance comes dangerously close to the definition of involuntary manslaughter, actions that are unnecessarily costing tens of thousands of lives, trillions of dollars of lost wages, profits and taxpayer dollars, and uncounted human misery.

Sampling President Trump’s Comments – And the Facts

The following President Trump quotes, and references to information available to him in advance of the COVID-19 global pandemic are taken from the Seth Meyers episode, "Trump Wants Everyone to Forget He Ignored Repeated Coronavirus Warnings: A Closer Look," "Late Night with Seth Meyers," April 8, 2020. A video of that 13:38 minute episode can be found here. Each quote is preceded by two numbers: the first is the time into the show where the quote appears, and the second is the date when Trump uttered the quote. Because the video shows Trump actually uttering these words no further documentation is provided of written sources that may have reported the remarks.

1:30 3/6/20 "I just think this is something, Peter, that you can never think is really going to happen."

1:37 3/6/20 "It's an unforeseen problem. What a problem. Nobody, nowhere."

1:40 3/11/20 "We're having to fix a problem that four weeks ago nobody ever thought would be a problem."

4:52 3/11/20 "You read about them. You read about them from 1917, and you read about them from lots of other times."

1:44 3/14/20 "It's something that nobody expected."

1:46 3/19/20 "I would view it as, it's something that just surprised the whole world."

3:57 3/19/20 "So there's never been anything like this in history. There's never been. Nobody's ever seen anything like this."

1:24 3/19/20 "Nobody could have predicted something like this. Nobody knew there would be a pandemic, or an epidemic of this proportion."

4:35 4/4/20 "Nobody's seen this, I would say since 1917, which was the greatest of them all. Probably the greatest of them all, right? 1917. There's been nothing like this since probably 1917. That was the big one."

11:50 4/4/20 "What have you got to lose? Try it."
The Seth Meyers' episode also listed the following briefings and reports that contradict the President's repeated statements that "no one knew" a global pandemic was coming.
"Obama officials walked Trump aides through global pandemic exercise in 2017: report"

"In 2017 and 2018 threat assessments, intelligence analysts even mentioned a close cousin of coronavirus by name, saying it had 'pandemic potential.'"

"In 2018 . . . the director for medical and bio-defense preparedness at the National Security Council, told a symposium that 'the threat of pandemic flu is our number-one health security concern.'"

"Top administration officials said last year threat of pandemic kept them up at night"

"White House Economists Warned in 2019 a Pandemic Could Devastate America"

"Intelligence report warned of coronavirus crisis as early as November: Sources"

"U.S. intelligence reports from January and February warned about a likely pandemic"

"Trade Adviser Warned White House in January of Risks of a Pandemic"

"Memorandum to President" (NSA, COS, Covid-19 Task Force), Feb. 23, 2020
Why Test-Trace-Quarantine-and-Test?

When I was a young boy, maybe four or five, I recall the day I slowly slid off of the front porch swing to go back in the house, looked up and saw an 8-1/2" by 11" poster tacked to the door and its bold, capital letters that spelled out “QUARANTINE.” I could not spell or pronounce it and had to ask my parents what it meant.

What it meant was that I was supposed to stay inside.

It was neither the first nor last time the Iowa City public health folks put it there. Who knows how many times our kindly family doctor brought his small black bag and came to see me. He would take my temperature, put on my chest the stethoscope he always wore like a necklace, give me one of his cherry-flavored candy “pills,” and tell me to rest.

This was not medical malpractice. There were simply no vaccines for what I had. And I had a variety, though the only ones I now remember are chicken pox, influenza, measles, mumps, pinkeye, strep throat and whooping cough. Having the disease – if it didn’t kill you – provided an immunity from getting it again, kind of like making your own vaccine.

So what’s this got to do with our current global pandemic? Simply this: the idea that quarantine is an essential element in fighting a pandemic is scarcely a new one.

On July 27, 1377, the city council of what is now Dubrovnik, Croatia, passed a law providing that “those who come from plague-infested areas shall not enter [the city] or its district unless they spend a month on the islet of Mrkan or in the town of Cavtat, for the purpose of disinfection.” Dave Roos, “Social Distancing and Quarantine Were Used in Medieval Times to Fight the Black Death,” History.com, March 27, 2020.

Of course, even if we were following the 1377 advice from Dubrovnik, and we’re not, in order for an area-wide quarantine to eradicate a disease it is necessary to know who has it.

Which brings us to the qualities of COVID-19 infections and possible responses to a coronavirus pandemic.

COVID-19 Basics
(1) The coronavirus can pass from one person to another.

(2) The number of infected persons increases exponentially. (See Exponential Growth, below.) As a result, delay is deadly. It means that one infected person may become three the next day, but two weeks later the one has grown to 16,000.

(3) Most significant, not everyone who is infected -- and therefore capable of infecting others -- displays symptoms.

Their symptoms may develop a few days after the infection, they may never show symptoms, they may be over their infection but still capable of infecting others.

Because we’ve only tested a small fraction of Americans, we cannot be certain how many of the infected have no symptoms (are “asymptomatic”). If we only, or primarily, test infected persons showing symptoms we will never know. However, a guess at 50 percent is probably in the ballpark. (See the percentages for Vò, Italy, and the cruise ship Diamond Princess in How to Eliminate COVID-19.)

(4) Are those who have survived the disease immune to a second infection -- similar to my childhood diseases? However reasonable a hypothesis worthy of testing, at this point we don’t know. Is such a person incapable of passing the disease to another? We don’t know that either.

Possible COVID-19 Responses
(1) Do nothing. Don’t be proactive (proactive examples: support research; create plans for responding to possible pandemics; maintain stockpiles of medicines, equipment, PPE (personal protective equipment for health care providers), test kits, identify facilities where the infected can be placed). Allow the virus to run its course; many will fall ill and some will die, but ultimately “herd immunity” will protect the surviving population – if the hope and assumption is valid that everyone, once infected, now has a lifetime immunity from the disease.

(2) Mitigation. Accept the fact that the disease will continue to spread exponentially but suggest practices that will reduce somewhat the number infected any given day. This would include recommending “social distancing,” “shelter at home,” limiting gatherings to 10 persons or less, in an effort to “flatten the curve” while accepting the increasing numbers of persons who have been infected or died.

(3) Concentrate on “hot spots.” Use triage to find and address those in close quarters, often with clusters of the infected with symptoms -- cruise ships and aircraft carriers, long term living facilities, schools and dormitories, manufacturing and industrial plants (such as meatpacking plants). (Our failure to be at least this rationale is inexplicable.)

Our Response
Our response has been a mix of (1) and (2).

Meanwhile, not only have there been a large body of official reports and scientific literature warning of the coming of this pandemic and the best ways to respond, there are numerous examples of what the successful countries have done.

Examples would include Australia, Germany, Hong Kong, Iceland, New Zealand, Singapore, South Korea, Taiwan, Vò (Italy) and Wuhan (China). See, for example, Peter Beaumont, “Coronavirus Testing: How Some Countries Got Ahead of the Rest,” The Guardian, April 2, 2020. Of course, some have been more successful than others; some have experienced a second wave once restrictions were lifted. But there was a similarity in the approach of each.

As the world’s scientists successfully demonstrated while they rid the planet of small pox (”History of Smallpox,”Centers for Disease Control and Prevention), the best way to fight a global pandemic is what would be today the “test-contact trace-quarantine-test” approach. It’s the most efficient, fastest, cheapest way to get an economy back to normal while holding lost lives and dollars to the absolute minimum.

Test everyone (not just those with symptoms), “trace” their contacts and test them, quarantine all who are infected, then test again to make sure you got everyone.

That’s what the world’s most successful coronavirus-fighting nations have done. It’s what we could have done.

But aren’t we beginning to test now? Yes, but with the exponential growth in infected people since last January we’ve already suffered the lost lives and trillions of dollars the approach could have saved.

As Letter to The Gazette put it:
Jan. 20 was the day both South Korea and the U.S. had their first CORVID-19 cases.

Twenty days later South Korea had flattened the curve. Along the way it had the second highest number of cases globally, but by April 20 the threat was over -- while keeping many businesses and factories open.

A Seoul official credits “quick government intervention, tracking and isolating infected personnel, and a transparent information hub” – plus a dozen amazing apps. All things we could and should have done.
Instead, our response is reminiscent of a bit from a Seinfeld episode. Jerry and Elaine needed a rental car, made a reservation, and went to pick up their car, only to be told there were no cars. Jerry says, “You know how to take the reservation. You just don't know how to hold the reservation. And that's really the most important part of the reservation. The holding." “The Alternate Side,” “Seinfeld,” Season 3, Episode 11 (video).

We understood the part about testing, we just missed the bit about “quick government intervention” and the need to test everyone.

On January 22 President Trump told a reporter, “It's one person coming in from China, and we have it under control. It's -- going to be just fine." (CNBC, "Interview: Joe Kernen Interviews Donald Trump on CNBC From Davos - January 22, 2020," Factbase, January 22, 2020)

Sadly, on January 22 we could have had “it under control.” We could have been “just fine.”

“Test-trace-quarantine-test” remains the only way to beat this thing (absent the miraculous appearance of a vaccine in less than 18 months). Thankfully, mitigation and “flattening the curve” do reduce the stress on hospitals and health care providers. But sadly, at this stage, it only prolongs the unnecessary loss of tens of thousands of lives and many trillions of dollars. It does not eliminate a spreading coronavirus -- as we could have done had we started on January 20 instead of April 20.

A Global Pandemic Calls for Global Solutions

Throughout the essays in this blog post I have often emphasized that the most effective response to a global pandemic, in terms of minimizing infections, deaths, costs and economic harm, is the test-trace contacts-quarintine-and test again approach. Thursday morning (May 7) I posted to my Facebook page:
The only way to beat a global pandemic is to eliminate every infection (as was done with smallpox). That requires testing everyone. As of this morning (May 7) the percentage of Iowans who have NOT been tested for COVID-19, 97.997%, is even slightly higher than the national average (97.66%). Just saying.
One of my rewards from blogging (in addition to knowing you actually read this far) is to discover -- after trying to think some issue through for myself, writing it up and posting it here -- that someone who has the credentials to write about it has come to the same conclusions.

So it was last evening when I awoke, looked to my iPhone for something to put me to sleep, and spent 15 minutes watching a TED talk. The speakers were persons new to me, epidemiologist and philanthropist Larry Brilliant, along with TED Conference curator Chris Anderson. Brilliant's talk was titled, "A Global Pandemic Calls for Global Solutions."

Here's how "TED" describes it:
"Examining the facts and figures of the coronavirus outbreak, epidemiologist Larry Brilliant evaluates the global response in a candid interview with head of TED Chris Anderson. Brilliant lays out a clear plan to end the pandemic -- and shows why, to achieve it, we'll have to work together across political and geographical divides. 'This is not the zombie apocalypse; this is not a mass extinction event,' he says. 'We need to be the best version of ourselves.'"
And here is the video:


Doing the Wrong Thing Better
"Much of what is published for boards ... teaches trustees how to do the wrong things better." John Carver, "Remaking Governance," American School Board Journal, March 2000, p. 26.
In 1998 I was elected to a three-year term on the School Board of the Iowa City Community School District. Iowa City's beloved Librarian of the Iowa City Public Library, Lolly Eggers, was a major participant in my campaign in many ways. As befits a librarian, one of those ways was to loan me her copy of John Carver's book, Boards That Make a Difference (1997). As it turned out, that book not only influenced my own thinking about the role of board members generally, but shapped much of what the School Board did during the next three years.

Many members of boards have given little thought to the process of governance, the inter-relationships between individual board members and "the board," which powers and functions are collaborative (with administrators or staff) and which are exclusive to the board. How would a board know if it was ever "successful"? If you're interested in more, and what it meant to our school board at that time, see the goverance page on my Web site "Board Governance: Theory and Practice".

I mention this because, as the opening quote indicates, even when one is going about a task the wrong way there may be an alternative that at least results in "doing the wrong thing better."

And so it is with American politicians; that is, the president and many governors, who have chosen to do the wrong thing to protect the health and lives of Americans -- as well as our economy.

There were ways they at least could have gone about "doing the wrong thing better."

The right thing, the approach of the world's leaders who most effectively and promptly eliminated the pandemic, saved their people's lives, minimized their misery, and most quickly restored their economies, is "test - contact trace - test contacts - isolate and quarantine - test again." Bear in mind, this is a virus that multiplies both fast and exponentially (and even more so among those clustered together), and does not create symptoms in roughly half of those infected. Moreover, the experts do not yet know how much, if any, immunity to the disease those once infected have gained by having once had it , whether they can get it again, and whether they are still spreading it to others. Without a vaccine that has been sufficiently tested to provide confidence it is both safe and permanently effective, totally erradicating the virus appears to be the only effective way of regaining both a nation's health and its economy.

To test and treat only those with symptoms -- and to fail to test anyone who is not already in a hospital with symptoms -- at best, substantially extends the time during which the numbers of infected and dead continue to grow. "Social distancing" and "shelter in place" efforts at "mitigation" and "flatening the curve" do reduce the stress on hospitals and health care providers, it's true, but they only lengthen the time before a nation's people and their economy can recover.

There are elected officials whose speech and action suggest they perceive a political advantage to minimizing the seriousness of the pandemic, attacking media reports and disparaging the experts, emphasizing the economy over public health by removing restrictions before it's safe to do so, and frustrating transparency regarding the numbers of infected and dying persons.

As long as they insist on doing "the wrong thing" how might they go about "doing the wrong thing better"?

What might we learn from the business strategy of focusing on one's "profit centers" and "cost centers"? As Peter Drucker, among others, pointed out in the 1960s, some businesses put 90 percent of their attention and resources into products or services that are only producing 10 percent of their profits.

Whether one's goal is to focus on care for others by improving health, reducing misery and death, or to focus on economic recovery, growth, profits and returns for investors, the answer is to go fishing where the fish are, to seek out and eliminate the virus where the percentages of infected persons are the highest. This might not be the best way to eliminate the virus from a nation, or the world, but it is at least "doing the wrong thing better."

The experts have known, predicted and reported where those places would be long before COVID-19 struck (a global pandemic that was itself predicted). They are places where people are gathered in groups, especially when those groups are large and contained within enclosed places -- as we've seen when the largest sources of the newly infected have been reported coming from cruise ships (and later aircraft carriers), long term living facilities (independent living, assisted living, and nursing homes), prisons, workplaces (such as meat packing plants), and other gatherings (such as indoor and outdoor sports facilities and megachurches).

And who within these groups are most likely to be seriously ill and even die? That also was known ahead of time: the elderly (those over 60, or 80), and those with pre-existing conditions that tend to weaken their immunity to disease.

So if a government official doesn't want to eliminate the global pandemic by testing and contact tracing everyone, where should they start, if they want to get the biggest, fastest, cheapest return on their efforts, the greatest boost to their economy and their political career, and the most support from those constituents who value humane policies or answers to "what would Jesus do"?

Why, nursing homes, of course. Iowa has 434. Nursing Home Inspect, Iowa, Propublica. That is where you will find the Iowans who are: the oldest, with the most diminished immunity, already needing health care, gathered together in an enclosed space.

So how have the President, Iowa Governor, federal and state governments, and the nursing homes responded? Not well. The Gazette reports (Rod Boshart, "Iowa sees deadliest day yet from coronavirus; Reynolds indicates state's peak of the disease has passed," The Gazette, May 5, 2020 [print edition: May 6, 2020, p. A1]) the following:
46 percent of the 207 Iowans who have died from the disease were 81 or older -- although they were only 5 percent of the 10,111 Iowans who have tested positive.

56 percent of those who have died were associated with Iowa's nursing homes.
(As another example from that story of rapidly spreading COVID-19 among those closely gathered in enclosed spaces was the outbreak at a Tyson's meat packing plant in little (7456 population) Perry, Iowa, in which 58 percent of the employees (730 of about 1260 employees) tested positive.)

In terms of preventing the spread of infection (as distinguished from treating those hospitalized with symptoms, who can often be identified without testing) the most productive focus is on those who are infected but show no symptoms (are asymtomatic). They are the stealth spreaders of the disease. How many of them are there? The percentages vary. Most individual reports I've read were around 50 percent. (See, e.g., "As Many as 50 Percent of People with COVID-19 Aren’t Aware They Have the Virus," Healthline.)

However, a New York hospital reported 88 percent of those testing positive were asymptomatic. Dena Goffman and Desmond Sutton, "We tested all our patients for coronavirus — and found lots of asymptomatic cases; Our New York City labor and delivery unit found 88 percent of infected patients had no symptoms," Washington Post, April 20, 2020.

Even if the Iowa Governor was insistent on not testing every Iowan, had she at least focused the state's efforts on a thorough test-contact trace-isolate/quarantine-and test again of every Iowa nursing home resident and staff member she could have cut Iowa's COVID-19 deaths in half, slowed the statewide spread dramatically, and sped up the state's economic recovery.

And that would have been how to "do the wrong thing better."

South Korea’s Awesome COVID-19-Fighting Apps

The source for the following information is Aylin Woodward, "South Korea controlled its coronavirus outbreak in just 20 days. Here are the highlights from its 90-page playbook for flattening the curve," Business Insider, April 18, 2020.
how many people were infected in each geographic area and city in real-time, constantly updating national and local government websites that tracked cases and the number of residents tested.

free smartphone apps that sent people emergency text alerts about spikes in infections in their local area.

important social-distancing protocols via text.

telemedicine via smartphone apps. Its Coronavirus-19 app, for example, gave patients the ability to input their symptoms and then get diagnosed with a cold or get connected to a doctor by phone, where they would be screened for coronavirus symptoms and given a preliminary diagnosis.

up-to-date information about the number and type of face masks currently available at any given store for purchase.

Once a resident tested positive, or was suspected of coming into contact with a coronavirus patient, the government encouraged users to voluntarily download self-quarantining apps that helped users monitor their condition and connect them to a doctor if needeed.

These apps also set off an alarm on a users' smartphone when they ventured out from a designated quarantine area.

After tests confirm a positive case, officials use interviews, GPS phone tracking, credit-card records, and video surveillance to trace an infected person's travel history

anonymized data about where each patient went before they were diagnosed on a public website so others can check to see if they have been near a patient.

two smartphone apps that provide information on the movements of confirmed patients in the region...

an app that sounds an alarm when users get within 100 meters of a place that a confirmed patient has visited recently.

another app helps employees plot the safest routes to and from work that don't intersect with previous paths of infected individuals.

an app to monitor symptoms of travelers coming into the country and provide them with medical advice.
Exponential Growth

To understand the existence of COVID-19, and means of eliminating its adverse public health, economic and political impact, one needs an understanding of a little bit of math. It's called "exponential growth."

In Joe Kernen's Davos interview of President Trump on January 22 he asked, "Are there worries about a pandemic at this point?" The President responded, "No. Not at all. And -- we're -- we have it totally under control. It's one person coming in from China, and we have it under control. It's -- going to be just fine." (CNBC, "Interview: Joe Kernen Interviews Donald Trump on CNBC From Davos - January 22, 2020," Factbase, January 22, 2020)

Let's contrast "arithmetic" growth (adding the same number every day; such as, 1, 3, 5, 7 and so forth) with "exponential" growth (such as 2, 4, 8, 16, 32 and so forth).

Suppose, hypothetically, for the 14 days following January 20 the infected person had infected 2 people every day. That would be an "arithmetic" increase (3 infected persons the next day, 5 the next day, 7 the day after that). The total after 14 days would be 29 infected persons -- clearly a substantial and worrisome increase over 1.

Now let's compare that with how many infected persons there would be after two weeks if the growth in the number was "exponential."

We need go no further than Wikipedia for a definition of "exponential": "The formula for exponential growth .... The growth of a bacterial colony is often used to illustrate it. One bacterium splits itself into two, each of which splits itself resulting in four, then eight, 16, 32, and so on. The rate of increase keeps increasing because it is proportional to the ever-increasing number of bacteria. Growth like this is observed in real-life activity or phenomena, such as the spread of virus infection...." ("Exponential growth," Wikipedia.org)

In other words, an exponential increase is not just the same increase every day, it is also a daily increase in the rate of increase. If every infected person infects two others every day, instead of the number of additional infected persons going from 1 to 3, 5, 7, and so forth, they would go to 2, 4, 8, 16, 32 and so forth.

So how many infected persons would there be after 2 weeks if the growth was exponential? 16,384. That's a lot more than 29, and more representative of what we're dealing with.

For an example from Iowa, during the first week of the reported infected (March 8-15) the number went from 3 to 18. Had the numbers continued to increase at that amount (15 per week) for the next 7 weeks our total on April 26 would have been 120 infected persons. During the last week, April 19-26, it went from 2,902 to 5,476 -- an increase of 2,574 (and a weekly average increase for the 8 weeks of 684 per week). (Bing, "COVID-19 Tracker," and "The latest: Another 384 cases reported in Iowa, 6 more deaths," Des Moines Register, April 26, 2020, 11:26 a.m.)

Why “Infamy”?

Curious about the use of the word “infamy” in the Gazette Letter, above?

It is not intended to suggest an analogy between the “attack” on Pearl Harbor by the Japanese military and the “attack” on the U.S. by the coronavirus.

Rather, the word “infamy” is used in its dictionary sense of an “extremely bad reputation, public reproach, or strong condemnation as the result of a shameful, criminal, or outrageous act.”

In short, the Letter’s use of “infamy” refers to the damaged reputation of a (usually public) person resulting from something they did (or as I use it, failed to do) not a reference to their behavior as such.

December 7, 1941 was the beginning date of the “infamy” of the Japanese. January 20 was the beginning date of the “infamy” of those among America’s political leadership – including the president – who failed to take the immediate actions taken by other world leaders to eliminate COVID-19 and its cost in deaths and dollars.

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Nick's COVID-19-Related Writing

"COVID-19 Home Test Kits & Other Thoughts"/"Find Your Household Thermometer," The Gazette, March 22, 2020

"COVID-19: Your Reading and References List," April 2, 2020

"How to Eliminate COVID-19," The Gazette, April 4, 2020

"January 20: Another Date in Infamy," The Gazette, April 26, 2020

"January 20: Another Date Living in Infamy," (the essays collection), April 30, 2020

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Thursday, April 23, 2020

Love on the Grass

. . . a dashed off, first draft thank you note

Who made this heart
I do not know
And placed it where
The grasses grow
Perhaps a little squirrel
I know
Whose nest survived
Through gales and snow
With secret skills
No man shall know
Or maybe Mr. Mallard for
His Mrs. Mallard
On creek's shore
What matters who has
Put it there
Or who walked by
And stopped to stare
It says "I love you,
All who pass"
Human, animal
And even grass

-- Nicholas Johnson
April 23, 2020

[Photo credit: Nicholas Johnson]

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Tuesday, April 07, 2020

Celebrating "возникают и расцветают"

One sunny spring April 7th decades ago Mother was sitting in her favorite chair on the kitchen porch when she called to me.

"See that little cluster of blue flowers over by the alley? Dig up a couple of those and plant them in the back yard. I think they would do well back there."

And so I did. And so they did.

Year by year more and more of these Siberian Squill make the pilgrimage to the back yard on April 7 each year for their four-day celebration of the birth and prolific lives of the two original flowers, following which they return home. They call the celebration "возникают и расцветают" (Russian for "Arise and Bloom").

Because each plant shares a sense of obligation to all the others they are immune to COVID-19 and can safely gather in this large annual grouping.

For years I have protected the flowers' privacy and said nothing about their "возникают и расцветают" celebration. But my understanding is that they are quite willing for me to tell you this year.





[Photo credit: Nicholas Johnson]
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Saturday, April 04, 2020

How to Eliminate COVID-19

How to Eliminate COVID-19
Nicholas Johnson
The Gazette, April 4, 2020, p. A6

There is a way to eliminate COVID-19.

Because we refused to use it months ago this lifesaving approach has passed us by. But it still holds lessons for what we can do.

Ironically, the best illustration of the strategy comes from Italy, the nation second only to the U.S. in numbers of infected people.

In the Veneto region of northeastern Italy lies the community of Vò Eugeneo, home to 3,300. It was the first Italian town to record a COVID-19 infection and death. [Photo credit: unknown]

On Feb. 21 two people were discovered to have the infection. The next day one died. By March 6 the University of Padua had designed and begun a study that required testing all Vò’s residents. Researchers discovered 90 infected people, traced contacts in their families, workplaces and neighborhoods. All who might be infected were quarantined. Two weeks later there were three. When their quarantine ended everyone was tested again, found free of infection, and the Veneto region’s Gov. Luca Zaia called Vò “the healthiest place in Italy.”

In another “community” with about the same population (3,700), at about the same time (Feb. 3), 10 people aboard the Diamond Princess cruise ship showed symptoms of COVID-19. On Feb. 4 the ten were put in a Yokohama hospital. The others were quarantined on the ship. When they disembarked, Feb. 19, all were tested. Roughly 20% (619) had contracted the virus. [Photo credit: Diamond Princess in Yokohama - wikimedia - By NEED - Own work, CC BY-SA 4.0]

In one case the number infected went from 3 percent to 0 percent. In the other it went from less than 1 percent to 20 percent.

In that difference is found how to eliminate COVID-19 — along with a warning why what Iowa is doing is so unnecessarily deadly.

It is as if our ceilings are leaking and our response is to mop while teenagers go buy more buckets. We are treating those with COVID-19 symptoms — as of course we must — while simultaneously increasing the number of those infected.

The brutal facts are that you don’t have to have symptoms to spread the disease. In Vò, everyone was tested. Those infected — with and without symptoms — were quarantined. On the Diamond Princess (as in Iowa) the focus was on those with symptoms.

How many infected people, capable of spreading the disease, have no symptoms? In Vò it was 45 percent. On the cruise ship it was 46.5 percent. [Chart: Increase in Iowa COVID-19 cases March 8-April 6; 946 confirmed, 25 fatal; Chart credit: Bing COVID-19 Tracker]

Even if we knew how many Iowans have symptoms, the number infected potentially spreading the disease is at least twice that.

The primary strategy we’re left with is mandated and enforced shelter in place. Governors who refuse to do that — and forbid their counties and cities to do it — will necessarily bear some responsibility for the resulting unnecessary deaths.

We lost the opportunity to test-trace-quarantine-and-test-again, so successful elsewhere. We failed to heed years of official and fictional predictions of this pandemic. We failed to resupply our stockpile of materials to fight it, and wouldn’t use WHO test kits. We cut support of federal public health programs and staff and were either unaware of or rejected their tested proposals for response. The costs of those failures in unnecessarily lost lives and trillions of dollars are behind us.

The least we can do is to not make it worse.

Nicholas Johnson, Iowa City, was co-director of the Institute for Health, Behavior and Environmental Policy. Comments: mailbox@nicholasjohnson.org

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Related Posts

COVID-19: Your Reading and References List; The Story, The Sources April 2, 2020 (sources used in the preparation of this op ed column, organized by categories)

"Find Your Household Thermometer" (blogpost: "COVID-19: Home Test Kits & Other Thoughts"), The Gazette, March 22, 2020, p. D2

And see the somewhat more upbeat but still relevant, "Celebrating 'возникают и расцветают'"



Tags: #asymtomatic, #CDC, #COVID19, #CruiseShips, #FlattenTheCurve, #hospitals, #Italy, #PPE, #PublicHealth, #SocialDistancing, #TestKits, #Ventalators, #VoItaly, #WHO

Thursday, April 02, 2020

COVID-19: Your Reading and References List

COVID-19: The Story, The Sources
Note: Researching while writing a column recently, I came upon the following sources. Rather than file them away, I arranged them roughly by subject matter and list them here in the thought others might find them a useful time saver. I will probably add to this list from time to time as we all continue to deal with the current COVID-19 pandemic. -- Nicholas Johnson, April 2, 2020.

General
Data and Other Sites
Center for Systems Science and Engineering, "Coronavirus COVID-19 Global Cases," Johns Hopkins University, updated regularly

"COVID-19 Tracker," Bing, updated regularly (data, charts: world, countries, states, counties)

World Health Organization

[Chart: Increase in Iowa COVID-19 cases March 8-April 21: 3,643 confirmed, 83 fatal; Chart credit: Bing COVID-19 Tracker. It took one month to reach 1048 cases, 26 deaths; 2 more weeks added twice that many cases and tripled the deaths.]

Centers for Disease Control and Prevention

Iowa Department of Public Health

The Gazette's "Rolling Updates on COVID-19 and its Impact," regularly updated stats and stories

Des Moines Register "Health News," links to COVID-19 stories

Neeltje van Doremalen, et al, “Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1,” New England Journal of Medicine, March 17, 2020

David Cyranoski, "Did pangolins spread the China coronavirus to people?; Genetic sequences of viruses isolated from the scaly animals are 99% similar to that of the circulating virus — but the work is yet to be formally published," Nature, February 7, 2020

Josephine Ma, "Coronavirus: China’s first confirmed Covid-19 case traced back to November 17; Government records suggest first person infected with new disease may have been a Hubei resident aged 55, but ‘patient zero’ has yet to be confirmed; Documents seen by the Post could help scientists track the spread of the disease and perhaps determine its source," South China Morning Post, March 13, 2020

"Coronavirus Business Resources,"The Gazette, regularly updated

Gregory Johnson, "Strategic Response," Facebook

Gregory Johnson, "The Smartphone App That Could Stop COVID-19 Already Exists," March 23, 2020
]
New York Times
"The Coronavirus Outbreak; News, Maps," New York Times, regularly updated

Mitch Smith, Karen Yourish, Sarah Almukhtar, Keith Collins, Danielle Ivory, Allison McCann, Jin Wu and Amy Harmon, "The Coronavirus Outbreak; Coronavirus in the U.S.: Latest Map and Case Count," New York Times, regularly updated (includes sources of cases; cases and deaths by state and county)

"The Coronavirus Outbreak; We're Sharing Coronavirus Case Data for Every U.S. County; With no detailed government database on where the thousands of coronavirus cases have been reported, a team of New York Times journalists is attempting to track every case," The New York Times, March 28, 2020, data regularly updated; this data is available here

"The Coronavirus Outbreak; Coronavirus Map: Tracking the Global Outbreak," New York Times, interactive, regularly updated

Sarah Mervosh, Denise Lu and Vanessa Swales, "See Which States and Cities Have Told Residents to Stay at Home," New York Times, regularly updates

Testing

Luigi Zingales, "Why Mass Testing Is Crucial," City Journal, March 27, 2020

Jason Horowitz, Emma Bubola and Elisabetta Povoledo, "Early Missteps Set Italy's Path to Catastrophe; The country’s experience shows that steps to isolate the coronavirus and limit people’s movement need to be put in place early, with absolute clarity, then strictly enforced," New York Times, March 22, 2020, p. A1

United States
General
"What You Need to Know About the Coronavirus, The Atlantic’s Guide to understanding COVID-19,” The Atlantic

Ed Yong, “Why the Coronavirus Has Been So Successful,” The Atlantic, March 20, 2020

Derek Thompson, “All the Coronavirus Statistics Are Flawed; Are we winning the war against COVID-19? In the fog of pandemic, we simply don’t know.” The Atlantic, March 26, 2020

Holshue ML, DeBolt C, Lindquist S, Lofy KH, et al, "First Case of 2019 Novel Coronavirus in the United States," New England Journal of Medicine 382 (10): 929–936 (quoted in "2020 coronavirus pandemic in the United States," wikipedia.org)

Amy Julia Harris, John Leland and Tracey Tully, "Nearly 2,000 Dead as Coronavirus Ravages Nursing Homes in N.Y. Region; The facilities knew that frail and aging residents were especially vulnerable to the outbreak, but they were unable to stop it," [print edition headline: "In Regions' Nursing Homes, 'Residents Are Sitting Ducks'"], New York Times, April 12, 2020, p. A1.
Blunders
For President Trump's desire to have the country "opened up" by Easter (April 12), see Annie Karni and Donald G. McNeil Jr., "Trump Wants U.S. ‘Opened Up’ by Easter, Despite Health Officials’ Warnings; 'You can’t just come in and say let’s close up the United States of America,' the president said, insisting again that he did not view the coronavirus as any more dangerous than the flu," New York Times, March 24, 2020 (for audio see the Times' "The Daily" on the page with this story, e.g., "I'd love to have it open by Easter," President Donald Trump).

Yasmeen Abutaleb, Josh Dawsey, Ellen Nakashima and Greg Miller, "The U.S. was beset by denial and dysfunction as the coronavirus raged; From the Oval Office to the CDC, political and institutional failures cascaded through the system and opportunities to mitigate the pandemic were lost," Washington Post, April 4, 2020

Steve Eder, Henry Fountain, Michael H. Keller, Muyi Xiao and Alexandra Stevenson, "430,000 People Have Traveled From China to U.S. Since Coronavirus Surfaced; There were 1,300 direct flights to 17 cities before President Trump’s travel restrictions. Since then, nearly 40,000 Americans and other authorized travelers have made the trip, some this past week and many with spotty screening," New York Times, April 4, 2020 [print edition headline: "430,000 Flew from China to U.S. After Virus Report," New York Times, April 5, 2020, p. 1]

Tom Frieden, “Former CDC head on coronavirus testing: What went wrong and how we proceed; Who should seek a test? Should we test everyone? How much will that even help? Let's clear a few things up,” USA Today, March 31, 2020

Michael D. Shear, Abby Goodnough, Sheilla Kaplan, Sheri Fink, Katie Thomas and Noah Weiland, "Testing Blunders Cost Vital Month in U.S. Virus Fight; Aggressive screening might have helped contain the corona virus in the United States. But technical flaws, regulatory hurdles and lapses in leadership let it spread undetected for weeks," New York Times, March 29, 2020, p. A1

Laurie Garrett, “Trump Has Sabotaged America’s Coronavirus Response; As it improvises its way through a public health crisis, the United States has never been less prepared for a pandemic,” Foreign Policy, January 31, 2020

Laurie Garrett, "Grim Reapers; How Trump and Xi Set the Stage for the Coronavirus Pandemic," The New Republic, April 2, 2020 (history of evolution of pandemic from roughly November 2019 through February 2020)

Donald G. McNeil Jr., "Did Federal Officials Really Question W.H.O. Tests for Coronavirus?" New York Times, March 17, 2020

Bethania Palma, "Did US ‘Refuse’ COVID-19 Testing Kits from the World Health Organization?" Snopes, March 17, 2020

Peter Baker and Maggie Haberman, "Trump Is Faced With Crisis Too Big for Big Talk," New York Times, March 22, 2020, p. A1

Early Warnings Ignored
Rem Rieder, "Contrary to Trump’s Claim, A Pandemic Was Widely Expected at Some Point," FactCheck.org, March 20, 2020

Jonathan Lemire, Zeke Miller, Jill Colvin and Ricardo Alonso-Zaldivar, "Signs Missed and Steps Slowed in Trump's Pandemic Response," Associated Press, Washington, D.C., April 12, 2020 ("Interviewed at Davos ... the president on Jan. 22 [said] 'It’s one person coming in from China, and we have it under control. It’s going to be just fine.' ... When Trump spoke in Switzerland, weeks’ worth of warning signs already had been raised .... In the ensuing month ... key steps to prepare the nation for the coming pandemic were not taken.")

Eric Lipton, David E. Sanger, Maggie Haberman, Michael D. Shear, Mark Mazzetti and Julian E. Barnes, "He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus; An examination reveals the president was warned about the potential for a pandemic but that internal divisions, lack of planning and his faith in his own instincts led to a halting response," [print edition headline: "Despite Timely Alerts, Trump Was Slow to Act; Pandemic Warnings Were Set Aside"], New York Times, April 21, 2020, p. A1 ("Throughout January, as Mr. Trump repeatedly played down the seriousness of the virus ... an array of figures inside his government ... identified the threat, sounded alarms and made clear the need for aggressive action.")

Michelle Goldberg, "Lawrence Wright Saw a Pandemic Coming; The journalist’s new thriller is eerily prescient. Too bad our leaders lack his foresight," New York Times, March 29, 2020, p. SR9

Nicholas Kristof, "2 Scenarios For Covid-19: Best and Worst," New York Times, March 22, 2020, p. SR2

"Coronavirus Live Updates: U.S. Extends Social Curbs After Estimate of 200,000 Deaths," The Coronavirus Outbreak, New York Times, live updates

Cruise Ships

Frances Robles, “‘God Knows How Many People We Infected,'" New Rules Aim to Get Exposed Passengers Home; Four people died on the Zandaam cruise ship after it was turned away in Chile. The United States is easing protocols to help speed cruise passengers home. But can that be done safely?" New York Times, March 27, 2020 [Photo credit: Diamond Princiess in Yokohama - wikimedia - By NEO-NEED - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=86578798]

"COVID-19 quarantine of cruise ship may have led to more infections," Medical News Today, March 3, 2020

Smriti Mallapaty, "What the cruise-ship outbreaks reveal about COVID-19," News, Nature, March 26, 2020

Other Countries’ Approaches

Katrin Bennhold, "A German Exception? Why the Country’s Coronavirus Death Rate Is Low; The pandemic has hit Germany hard, with more than 100,000 people infected. But the percentage of fatal cases has been remarkably low compared to those in many neighboring countries," New York Times, April 5, 2020, p. 9 [online April 4 and 6; print headline: "Testing, Tracking and Trust: Why a Death Rate Is So Low"]

Meghna Chakrabarti and Hillary McQuilkin, "Lessons From Singapore, Hong Kong and South Korea's Response to Coronavirus," On Point, WBUR, March 25, 2020

Oeindrila Dube and Katherine Baicker, "Lesson From Ebola: Collective Action is a Must; How an epidemic was curtailed by community involvement," New York Times, March 29, 2020, p. BU8

Vò, Italy
, wikipedia.org

Lorenzo Tondo, "Scientists say mass tests in Italian town have halted Covid-19 there; A study in Vò, which saw Italy’s first death, points to the danger of asymptomatic carriers,” The Guardian, March 18, 2020

Michela Nicolussi Moro, “Coronavirus, ora sono 43 i contagiati veneti. Il focolaio resta Vò; Parte dei positivi al test sorvegliati a casa Tende davanti a tutti gli ospedali. «Paziente zero», falso allarme,” Corriere Del Veneto, February, 25, 2020

Rosie McCall, "Coronavirus Mass Testing Experiment in Italian Town Appears to Have Halted COVID-19 Outbreak,"> Newsweek, March 19, 2020

Andrea Crisanti and Antonio Cassone, "In One italian Town, We Showed Mass Testing Could Eradicate the Coronavirus; By Identifying and Isolating Clusters of Infected People, We Wiped Out Covid-19 in Vo'," The Guardian, March 20, 2020 (audio file)

"Coronavirus, 50-75% casi a Vo’ Euganeo asintomatici: “Fonte di contagio, errore isolare solo malati.”, fanpage.it, March 16, 2020

Nicole Winfield, Colleen Barry and Trisha Thomas, "Italy hopes virus is easing but fears new onslaught in south," Associated Press/Washington Post, March 27, 2020

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Related Posts Tags: asymtomatic, CDC, COVID-19, cruise ships, flatten the curve, hospitals, Italy, PPE, public health, social distancing, test kits, ventalators, Vo' Italy, WHO

Sunday, March 22, 2020

COVID-19: Home Test Kits & Other Thoughts

Find Your Household Thermometer
Nicholas Johnson
The Gazette, March 22, 2020, p. D2

Like to get a COVID-19 test? South Korea tests 15,000 a day. That’s more than the U.S. tested in three months.

Your test is weeks or months away. You can’t fly to South Korea. What to do?

A symptom of COVID19 is fever. A quick test for large groups is individuals’ temperature. Look around your residence. You may have a thermometer. If not, buy one. Use it. If it registers under 98.6 F (37 C) that’s some evidence you’re not, yet, showing symptoms. Of course, you may be infected, but in your incubation period, or asymptomatic. But you’ll know more than you know now. You’re welcome.

Nicholas Johnson
Iowa City

A version of this Letter was sent to both The Gazette and Press-Citizen on Monday, March 16. The Gazette version, above, was published earlier online as "A common household item to help track COVID-19," The Gazette, March 20, 2020.



An earlier version was published by the Press-Citizen: Nicholas Johnson, "Your At-Home Test Kit," March 18, 2020, p. A7. It could not be found online. It read:
"Like to get a COVID19 test? South Korea tests 15,000 a day. That’s more than the U.S. tested in three months. To move the focus from President Trump's 'numbers' we're told to wash our hands. Like this is our fault. What we've not been reminded (as of this writing) is the little test kit most of us already have: a thermometer, a device used to quickly examine large groups. Find yours. Clean it well. Use it:. If it registers under 98.6 F (37 C) the odds are extraordinarily good you are not, yet, showing symptoms of the disease. You're welcome." Nicholas Johnson, Iowa City.
[Photo credit: Centers for Disease and Prevention via Wikimedia.]

Discussion

Why a letter? The shorter, letter-to-the-editor, form (rather than a column) was used in hopes it might speed the publication and distribution of this information. Although there was always mention by public officials and media of "fever" as one of the COVID-19 symptoms (along with coughing and difficulty breathing), and a couple mentions of thermometers this past week, at the time the Letter was drafted (March 15 and 16) I was unaware of any public mention of thermometers in the context of the discussion regarding the seemingly insurmountable shortage of test kits.

Why more "discussion"? Because there is so much more the public needs to know about testing than could be put in the Letter, hopefully this additional "discussion" can provide some of that.

What COVID-19 test kits can and cannot do. Had the Administration begun building up the necessary supplies, including test kits, when we first learned of the Chinese experience in December, or in January, when it was alerted to the serious risk and the first infected patients emerged, it could have begun the successful Korean approach at that time. That opportunity is now lost. We still need the kits for those at highest risk (over age 85 with other medical conditions), those experiencing all the symptoms -- those that doctors want, but are unable, to have tested. But tests have their limits. The CDC's first test kits apparently had serious faults. There are still false positives and negatives. And the biggest drawback is that, unless you are tested every day, the test results only report your condition on the day and time you were tested.

What thermometers can and cannot do. Of course, thermometers also only report your temperature as of the day and time you use them. But, unlike COVID-19 test kits, you can use your thermometer multiple times a day for no additional cost and without depriving anyone of a thermometer.

Fevers result from your body healing itself. (That's one reason not to take fever-reducing pain medicine, if you can tolerate the pain, because these meds reduce the benefits of fever.) Fevers may be caused by many medical conditions including inflammations, bacterial infections and viruses.

What is said to be a "normal" temperature (98.6 F, 37.0 C) may still be considered "normal" if within a range of 97-99 F (36.1-37.2 C). Temperatures are considered serious once they reach 103 F (39.4 C) or above.

If you are running a temperature of any amount, and especially if below the serious level, it does not mean that you do have COVID-19 -- especially if you have none of the other symptoms. Similarly, if you have no "fever" or other symptoms it does not mean that you do not have the virus. During the disease's incubation period you will have no symptoms. You can be infected but have none of the symptoms (be "asymptomatic"). You can be infected but have such mild symptoms that you easily recover. But by taking your temperature twice a day (and making a permanent record of it; it's usually lowest in the morning) you can at least track one of the principal symptoms of the virus.

Conclusion. Thermometers are not a magic cure for COVID-19. They are not the equivalent of a COVID-19 Test Kit. But they are widely available, within the financial ability of almost everyone, and used daily can give you trend lines regarding this one symptom of our current pandemic.

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Tags: COVID-19, COVID-19 symptoms, fever, temperature, test kits, thermometer, virus